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چکیده
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Type 2 diabetes mellitus (T2DM) is one of the major complications of obesity and overweight. Several factors such as inactivity, high blood pressure, and hyperlipidemia might lead to a higher risk of cardiovascular complications by increasing HbA1C, weight, and body fat in these patients. Lipocalin family proteins include retinol-binding protein 4 (RBP4), fatty acid-binding proteins (FABP), and lipocalin-2. Recent studies have suggested that these proteins, as novel inflammatory markers, may affect signaling pathways in patients with obesity and T2DM. Recently, lipocalin-2, an adipocyte-derived and acute-phase protein, has been correlated with potentially positive effects on obesity and inflammation. Its elevated level activates inflammatory signaling pathways in patients with diabetes, and it is also associated with cardiovascular diseases. RBP4, a fat-derived adipokine, mainly secreted by adipose tissue and liver, systematically increases insulin resistance in humans and mice. Recently, declining RBP4 activity has been suggested to reduce insulin resistance and improve cell function in patients with diabetes. It has been reported that resistance training for eight weeks is associated with a significant decrease in the concentrations of FABP4 and Lcn2 in obese adult males. Aerobic training simultaneously improve cardiovascular state, muscle strength, endurance, posture, and flexibility. In particular, the cardiovascular system benefits from swimming because it improves the body's oxygen usage without causing the heart to overwork. One of the reasons water aerobic exercise was chosen is the unique characteristics of the population studied. For patients with T2DM, even daily routine is physically hard. Water aerobic exercise has many benefits: exercising in water requires to support only 50% of body weight; the risk of injury is comparatively lower on account of its low-impact character; stress and compression on the joints are low, and the resistance offered by wate
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